UNIVERSITY OF CALICUT

for office use only

Calicut University Teacher Education Centres

1. Vatakara 2. Chakkittapara 3. Calicut 4. Kaniyambetta 5. Sulthan Bathery 6. Manjeri 7. Malappuram 8. Koduvayur 9. Aranattukara 10. Valapad 11. Nattika

Degree (Part III Main)

PG-optional subject

APPLICATION FOR ADMISSION TO B.Ed COURSE FOR THE YEAR 2014-15

(Please read the prospectus carefully before filling the Application form) 1. Optional Subject selected for B.Ed 2. Name of the Applicant in English (in Block letters)

in Mother tongue 3. Name of the Parent/Guardian 4. Sex M / F

5. Address to which communications are to be sent (in capital) Permanent Address

6. Marks obtained for the qualifying examination (Part III /Double Main/Triple Main/M.Com). OR Grade obtained for the qualifying examination (Part III /Double Main/Triple Main/M.Com).

Secured Percentage Maximum

Course CGPA Percentage

Core Course

Complementary Course-I

Complementary Course-II

Space for affixing

Photograph

E-mail Phone No

Mobile No: Pin

Phone No

Mobile No: Pin

Details of fee paid

Chalan No.

Date

Treasury

1. Percentage of marks B.A/B.Sc.(Part III)/M.com

2. Nativity

3. Degree from University of Calicut

4. Weightage of marks for M.A./M.Sc. in the same subject

5. Teaching Experience

6. N. C. C.

Total for 1 to 6

7. Number of chances (01, 02 etc.) 8. Marks secured for Post graduation in the same subject

OR Grade secured for Post graduation in the same subject

9.. Nationality/Religion/Caste/Community

10. Quotas under which applications are to be considered (enter code(s))

11. Whether the candidate is a Permanent Teacher in an Aided/Govt.School. : Yes / No 12. Teaching Experience (as on date of notification) 13. Whether you belong to the District under the Yes / No University of Calicut jurisdiction.

14. Whether you have graduated from Yes / No University of Calicut

15. Whether claiming weightage for PG in the Yes / No same subject. 16. If Double/Tripple Main, maximum marks/grade obtained in the main subject applying now. Yes / No 17. Annual Family Income Rs.

18.. Do you belong to SC/ST/ETB/Muslim/OBH/LC/SIUC/OEC if so, state the community and attach attested copies of Community and Income Certificates.

19. Name of the District to which you belong (Attach Nativity Certificate for claiming Nativity weightage) Residential Certificate is not acceptable.

20. Whether applying for the quota of Ex-Service men/Dependant of Ex-service men/Dependants of Serving personnel. (Attested copies of certificates stating relationship with the personnel should be produced.)

21. Specify whether applying for Teachers/ Linguistic/ Minority/Lakshadweep/Sports/Handicapped (Visually/ Orthopeadically). Attested copies of certificates should be attached.

22. Teaching experience in Govt. School/Aided School (In case of candidates applying under Teachers quota and those applying under general merit claiming weightage for teaching experience, certificate countersigned by the A.E.O./D.E.O./R.D.D should be produced in the form IV of KER)

23

Whether claiming weightage for NCC

(If so, attach copy of the certificate from the competent authority)

Secured Percentage

Gen.Merit Teacher

Ex-service/Serving Personnel

Handicapped Native of Lakshadweep

Linguistic Minority

Sports

Years Months Days

24. Educational Qualification (Self attested copies of mark lists/consolidated grade cards should be enclosed)

Details of qualifying examinations

University Subject Reg. No.

Year of passing

Marks Class obtained with % of

marks

Chances taken Awarded Maximum

BA/ B.Sc

Part III Main and Sub.

Double Main

/Triple Main

Main-I

Main-II

Main-III

MA/M.Sc/ M.Com

GRADING SYSTEM

Grade

CGPA secured

% of marks

BA/ B.Sc

Core Course or Main-I

Complementary Course-I or Main-II

Complementary Course-II or Main-III

MA/M.Sc/ M.Com

List of enclosures 1.

2.

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7.

8.

DECLARATION

I do hereby declare that the details given above are true and correct and that I will obey all the rules and regulations of the University and the Teacher Education Centre.

Place: Date:

Signature of the Applicant